EMR/Paper Charting of Blood Bank Results

[MissyR]

We have asked our HIMS department if there are any regulations that they are aware of that require the recording of blood bank results in the patient's medical record, be it an EMR or paper chart. Specifically, we were wondering about compatibility testing. It currently prints out on our paper charts from Classic, which we send to HIMS for charting. We will be moving to SafeTraceTx next year. So, several questions for the group:

1. What if any results are being placed on the patient's medical record?

2. Does your facility use a paper chart? EMR?

3. If EMR, what system are you using?

Many thanks in advance!

[Mabel Adams]

We have SafeTrace Tx (Horizon Blood Bank) interfaced to Horizon Lab which is interfaced to the McKesson Horizon EMR. Our small sister hospital is still on paper charts but uses HBB in BB. They print results reports from the BBIS every day to send to the chart. There is something quirky about those reports though, isn't there? Like they only show the Type and Screen or something? I haven't looked at them in several years. Anyway, that's all we sent to the chart before we were interfaced. We create a transfusion record that shows the crossmatch and gets scanned into the chart for all units that are transfused.

[tbostock]

We have an EMR (Epic) interfaced with our Blood Bank LIS (SoftBank). In Epic they can see the Type and Screen and other tests (DAT, etc). The units only show the unit number and status (transfused, released, etc). It does not show compatibility status, or antigen typing results. We had an inspector ask us why physicians did not want to see these, I have never had a physician that was concerned. Most really just want to know that blood is ready.

[MissyR]

That's what we told our HIMS director. We emphasized that the transfused units are displaying in the EMR. Her concern was does this information impact clinical care or is used to make treatment decisions. We told her that there was a decision to transfuse based on other laboratory results or other clinical reasons. If there is a question of least incompatiblity, then there is discussion between the blood bank and ordering clinician. Thanks for the replies, sometimes it's just nice to know what we are all doing!

[bldbnkr]

Hi,

We have SoftBank and the hospital has Clinical Suites for reporting. We just recently instituted Nursing Order entry into Clinical Suites, which in turn is interfaced with SoftBank and generates type and screen and product order.

Our next step will be to go paperless as far as the transfusion slip (record) is concerned. This is somewhat more problematic when we look at our current process and try to replicate. We are wondering how other hospitals do the two nurse check at the time of hanging the product. Currently they read from the paper and the blood bank and the patient's wrist band. Going paperless it seems pointless to read the ABO/Rh and donor number of the blood bag against what? The SoftBank label? It is not easy to get to the crossmatch report in their computer while they are checking off the flowsheet in Clinical Suites.

[SMILLER]

I would also be interested in how you deal with "paperless" transfusion tags in the world of EMRs. Like most hospitals at this point, we are still currently sending out units with a tag/logsheet that includes a carbon. A sticker from the tag has unit and demographic info. This sticker is stuck to the back of the unit when released from BB.

At the bedside, after the read back and armband check, the tag is removed when the unit is hung. Vitals, etc are recorded on the tag. The carbon is sent back to the BB for later review. The top tag copy goes in the chart.

With the MR, the tag can't be put into anything. Not sure if it going to be practical to enter vitals, etc into the EMR at the bedside when the time comes for conversion. Perhaps the tag can be used as a worksheet to enter into the EMR and then returned to BB for review? As far as that goes, I guess BB should be able to review on the EMR. Maybe the tag will be totally superfluous? Just the sticker with patient name, ID, etc. and unit info going on the bag when it leaves the BB?

If anyone has fully converted, I would be interested in how this is going for you.

Thanks, Scott

[Townsend]

We use Epic EMR and Sunquest (Misys) LIS and almost all of our inpatients and clinics are now electronic rather than paper. Like Terri, the test results are viewable as well as each type of component allocated and the final status. We do not send the compatibility results to Epic via the interface.

When a unit of blood is issued, it has the compatibiliy tag attached that prints from the LIS. This includes the unit details and results of the compatibility testing, which must be reviewed by the transfusionist at the bedside (with a second RN) prior to administration. The majority of the units are able to document the transfusion (vitals, bedside check, volume, unit #, etc) directly into Epic on the "blood administration flowsheet".

There are a few areas not yet using the EMR which must use the paper form attached to the blood product. The checklist on the paper form matches the checklist in Epic, and if the paper form is used, it is eventually scanned into Epic. I don't think that the paper form/tag will ever go away since it is also used whenever there is Epic downtime or can be used in an emergency when electronic charting might not be done in real-time. (that's a whole other discussion:))

Stephanie

[SMILLER]

Stephanie,

Thanks. What happens to the tag after they are done with it and everythiing is in the EMR? Does it go back to the BB? Discarded? And do you review each transfusion record on the EMR? Currently we use the back copy of the tag to do this.

Scott

[AMcCord]

All the transfusion documentation is done in the patient EMR at my facility. The flowsheet built in the EMR for that purpose is on one screen and has a place for entry of all the required information like unit #, outdate, infusion set lot #, time started and vitals, 15 min vitals, time ended and vitals, consent signed, orders from Dr checked, transfusionist name, 2nd nurse name for check at bedside (and whatever else I forgot). This was a custom build done in house by our LIS staff. The nurses don't seem to have any problems with it and all the lovely labeled boxes remind them of what needs documented. They have laptops at bedside for patient charting. I don't think it would work as well without the laptops right there at bedside.

Surgery is the only place not using the EMR for transfusion documentation. They still use the paper form we were using before we went on line with the EMR. It's a 2 part carbon - one part comes to us for review and the other part is scanned into the EMR.

On nice thing about it for me is that to do a chart review, all I have to do is pull up the flowsheet - everything (except the actual physician order and consent form) is right there in one place.

Edited May 18, 2012 by AMcCord

[Townsend]

Scott, we're pretty much the same as AMcCord. They still send back a carbon copy to the blood bank, but most areas use the EMR so everything can be pulled up to do audits. We audit the electronic documentation of a random sample of transfusions per month and rotate the nursing units. (we do about 12,000 transfusions per year, so we might audit about 50 txns per month)

Stephanie

[Mabel Adams]

In both places I have worked in the past few years we have managed to get Nursing to audit their own transfusion records for completion at least. We do not get anything returned to Blood Bank unless there is a reaction. We are still using paper for transfusions even though we have an EMR. At my last job, even without an EMR nursing had a sheet for charting transfusions that they produced with all the vitals etc. on it. It never made sense to me why Blood Bank was creating their chart form and sending it up with the unit. We issued the unit with a compatibility tag that listed the patient ID, compatibility and the usual unit info. It was a little awkward for the 2 nurse check but it made sure they were putting more energy into checking that the unit matched the patient than that the unit matched the paperwork.

[bbanker2]

Question for you folks that are entering into the EMR...

 

Are you AABB accredited?

 

We are contemplating whether or not we want to continue to print a Blood Product slip with a space for vitals.  We'd like to start putting into the EMR as well.  I can't find where the AABB says there needs to be a paper copy but thought I'd ask the experts.

 

Thanks!!!!

[tbostock]

No, there is no reg where it says it has to be on paper. We are moving our entire blood administration process to the EMR. Everything will be documented in our HIS directly by nursing.

[macarton]

We are on Meditech Client Server and went live with TAR the first of the year.  We have surgery, ER, Endo, and Infusion Clinic not on Meditech, so we still print a transfusion slip and attach to every unit.  If the unit is completely given in TAR, then the slip is discarded with the unit.  If started on the floor and finished in OR or Endo then those fill out their part manually and we finish recording in Meditech when we get the transfusion slip back. Same if started manually in OR, ER or Endo, the floors finish manually and return the document to us for recording in Meditech.  We keep a copy and original is posted on the chart and Med Records scans it into the EMR when patient is discharged.